Rühmann O, Wirth C J, Gossé F, Schmolke S
Hannover Medical School, Germany.
J Bone Joint Surg Br. 1998 Jan;80(1):109-13. doi: 10.1302/0301-620x.80b1.8195.
Most brachial plexus palsies are due to trauma, often resulting from motorcycle accidents. When nerve repair and physiotherapy are unsuccessful, muscle transfer may be considered. Paralysis of the deltoid and supraspinatus muscles can be addressed by transfer of the trapezius. Between March 1994 and June 1997 we treated 38 patients with brachial plexus palsy by trapezius transfer and reviewed 31 of these (7 women, 24 men) after a mean follow-up of 23.8 months (12 to 39), reporting the clinical and radiological results and subjective assessment. The mean age of the patients was 29 years (18 to 46). The operations had been performed according to the method of Saha described in 1967, involving transfer of the acromion with the insertion of the trapezius to the proximal humerus, and immobilisation in an abduction support for six weeks. Rehabilitation started on the first postoperative day with active exercises for the elbow, hand and fingers, and electrical stimulation of the transferred trapezius. All 31 patients had improved function with a decrease in multidirectional instability of the shoulder. The average increase in active abduction was from 7.3 degrees (0 to 45) to 39 degrees (25 to 80) at the latest review. The mean forward flexion increased from 20 degrees (0 to 85) to 44 degrees (20 to 90). Twenty-nine of the 31 were satisfied with the improvement in stability and function. Trapezius transfer for brachial plexus palsy involving the shoulder improves function and stability with clear subjective benefits.
大多数臂丛神经麻痹是由创伤引起的，通常源于摩托车事故。当神经修复和物理治疗失败时，可以考虑肌肉转移。三角肌和冈上肌麻痹可通过斜方肌转移来解决。1994年3月至1997年6月，我们采用斜方肌转移治疗了38例臂丛神经麻痹患者，并在平均随访23.8个月（12至39个月）后对其中31例（7名女性，24名男性）进行了复查，报告了临床和放射学结果以及主观评估。患者的平均年龄为29岁（18至46岁）。手术按照1967年萨哈描述的方法进行，即将附着有斜方肌的肩峰转移至肱骨近端，并在外展支架中固定六周。术后第一天开始康复治疗，包括对肘部、手部和手指进行主动锻炼，以及对转移的斜方肌进行电刺激。所有31例患者的功能均有改善，肩部多方向不稳定情况减少。在最近一次复查时，主动外展平均增加幅度从7.3度（0至45度）提高到39度（25至80度）。前屈平均从20度（0至85度）增加到44度（20至90度）。31例患者中有29例对稳定性和功能的改善感到满意。对于涉及肩部的臂丛神经麻痹，斜方肌转移可改善功能和稳定性，具有明显的主观益处。
